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Home My WebLink AboutHOMESTEAD HILLS BLK 2 LT 6Homestead Hills Block 2 Lot 6 #015-173-21 <` MUNICIPALITY OF ANCHORAGE w DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑ NEW -1 Sa brlr Cnll,5Trd 6iY ji UPGRADE MAILING ADDRESS �} LEGAL DESCRIPTION/ f .1 Wl ! " I Al//'As, SZ �. R LOCATION N0. OF BEDROOMS DISTANCE TO: Well Absorption area �c�f Dwelling �t PERMIT NO. 8 D2� 2 —Y I_ F Manufacturer /t Greer Material5� No. of compartments / Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth 6�Z DISTANCE TO: Well Dwelling PERMIT NO. O < Manufacturer Material Liquid capacity in gallons LU DISTANCE TO: Well/ � Foundation Nearest lot line PERMIT NO. F LL Z Zw No. of lines Len th of each line Total lenX of lines Trench width Distance between lines 4-5gth " inches cc:f Top of tile to finish grade Material beneath tile 1 Total effect ve absorption area o 3 7z inches 1Z5 M, Length Width Depth PERMIT NO. w Qa H LU Type of crib Crib dia t r Crib depth Total effective absorption area LU m DISTANCE TO: Well r I Building foundation Nearest lot line Ct1MWjj Depth Driller Distance to lot line PERMIT NO. —+ 0 w DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER P D r'i li 7 6 A - PIPE MATERIALS T o ? l . 2-q rZ7 S01 L TEST RATI NG 275 a' a2R \ INSTALLER 6 01 15ay L'0msf MC41Or\ REMARKS M06" - Ex //qyy GF ai t ` r6 13 iJ /Corwin :° v N6 C`E \ NA � ji O iiaG�''a`�'� bu: /' ` /'(/ j _A)AN A PI i APPROVED DATE LEGAL j �'•%, �/"// /`fI �� .- 1 r/ /n t7,7 i.M�S fin // A';/S S22 7 /ZA/ K�bl� A Municipality of Anchorage 1, 1985 POUCH 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Laura A. Seeley Corwin and Associates 1549 East Tudor Road, Suite 204 Anchorage, Alaska 99507 Subject: Lot 6 Block 2 HomesteadHills' Subdivision Lot 27 Block 2 Paradise Valley Subdivision We received the as-builts for the above referenced properties, however, the applicant only delivered the yellow copy of the as-builts. He said the white original was blown away. Please submit new original as-builts or a recertified(original stamp and signature) copy. Thank you. If there are any questions, please call me at 264-4720. Sincerely, Laura J. Ward Acting Engineering Tech II LJW cc: to file PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 850232 05/28/85 ISABELLE CONST, P.O. BOX 00067 AN�HORAGE� AK 99510 243�5845 � LEGAL DESCRIP: �UBDIVISION: HOMESTEAD HILLS LOT: 6 BLOCK: 2 GECTION: 22 TOWNSHIP: 12N RANGE� 3W LOT SIZE: 43560 (SQ"FT, OR ACRES) MAX 4.1 Listed below are the options available tc` you if desig�ing yourseptic system, Choose the option that b�st �its your site, . ... ..... ... ..... ..... -_~__��~_~�__�_^~�~~'��~ if w. �� = ��][P� DEPTH TO PIPE BOTTOM (FT") 3,0 ** � 3,0 ** 3,0 ** GRAVELDEPTH TOTAL DEpTH (FT.) 9"0 GRAyEL WIDTH If ' 2"5 GRAVEL LENGTH (FT.) 92.O ** 54,0 119.0 ** GRAVEL VOLUME <rU,YDS,� 55`4 54`0 88"2 `�75 242 275 ** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4,O FT, MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE IAjNS (NOT EXCEE^ING 75FT. ,ACH) `** TANK MUST H�VE AT LEAST TWO COMP�RTMENTS �-~~..... ... ��_��.~~_��_~.. I I. A. at: 1" I am {amiliar with the require�ents �or m: -site .;:I and wellsas set �orth by the Municipality o� Anchorage (MOA) and the State o[ Alaska� ^ 2. Ii*ill install the system in accordance with al, MOA codes and regulations' and in compliance with the design criteria oI this p�rmit. 3" I will adhere to all MOA andState o� Alaska requirements {or t�e se� back distances yrom �ny existing wellr wastewatec disposal system or public sewerage syste� on this or a:y �djacen� or nearby lot. 4, I understand that this �er�it is valid [or a maximum o� 4 bedrooms an� an, ddit.onal permit, � IF A LIFT STATION IS INSTALLED IN AN AREA CO»ERED BY MOA B�ILDING CODES� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3> THE ELECTRICAL WORK MUST BE DONE BYA LICENSED ELECTRICIAN. SIGNED _... ..... ^~_... ..... �~ APPLICANT� ISABELLE CONST. / ' y . n �, ^ �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL P�OTECTION 825 L STREET� ANCHORAGE; AK 995O'1 264~4720 ' ^ ' �� PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 850232 05/28/85 ISABELLE CONST, P.O. BOX 00067 AN�HORAGE� AK 99510 243�5845 � LEGAL DESCRIP: �UBDIVISION: HOMESTEAD HILLS LOT: 6 BLOCK: 2 GECTION: 22 TOWNSHIP: 12N RANGE� 3W LOT SIZE: 43560 (SQ"FT, OR ACRES) MAX 4.1 Listed below are the options available tc` you if desig�ing yourseptic system, Choose the option that b�st �its your site, . ... ..... ... ..... ..... -_~__��~_~�__�_^~�~~'��~ if w. �� = ��][P� DEPTH TO PIPE BOTTOM (FT") 3,0 ** � 3,0 ** 3,0 ** GRAVELDEPTH TOTAL DEpTH (FT.) 9"0 GRAyEL WIDTH If ' 2"5 GRAVEL LENGTH (FT.) 92.O ** 54,0 119.0 ** GRAVEL VOLUME <rU,YDS,� 55`4 54`0 88"2 `�75 242 275 ** DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION ** DEPTH TO PIPE BOTTOM < 4,O FT, MAY REQUIRE A LIFT STATION ** GRAVEL LENGTH > 75 FT, REQUIRES MULTIPLE IAjNS (NOT EXCEE^ING 75FT. ,ACH) `** TANK MUST H�VE AT LEAST TWO COMP�RTMENTS �-~~..... ... ��_��.~~_��_~.. I I. A. at: 1" I am {amiliar with the require�ents �or m: -site .;:I and wellsas set �orth by the Municipality o� Anchorage (MOA) and the State o[ Alaska� ^ 2. Ii*ill install the system in accordance with al, MOA codes and regulations' and in compliance with the design criteria oI this p�rmit. 3" I will adhere to all MOA andState o� Alaska requirements {or t�e se� back distances yrom �ny existing wellr wastewatec disposal system or public sewerage syste� on this or a:y �djacen� or nearby lot. 4, I understand that this �er�it is valid [or a maximum o� 4 bedrooms an� an, ddit.onal permit, � IF A LIFT STATION IS INSTALLED IN AN AREA CO»ERED BY MOA B�ILDING CODES� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3> THE ELECTRICAL WORK MUST BE DONE BYA LICENSED ELECTRICIAN. SIGNED _... ..... ^~_... ..... �~ APPLICANT� ISABELLE CONST. / ' y . n t i 9�-' SOILS LOG •p. MUNICIPALITY OF ANCHORAGE 9�-PERCOLATION r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST I� /! 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �e`(c 060-Ic4y4'4.1. (.e('1 DATE PERFORMED: LEGAL DESCRIPTION: LO� / `�� Ftnaf�lrL?!l' Ir�fl -� //e+�/({k35-Sfr .%2 SLOPE SITE PLAN -T r -TT - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMM 01�6"vfc AIA 7- s&TY sA/W/ Ir / A611FL d rrJ�Cp w((of �-1ed ar X39 d�rC i WAS GROUND WATER S ENCOUNTERED? tA0 L C P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net .Drop a:4� c�sl 10 0.37 a).i� Nab a:s� a. So 3:0� lC o,�3 D.o7 b.� +QY,o a: 2 l0 0.5b 0- � 44 O 61 O.yY 0,06 PERCOLATION RATE t[� % $ (minutes/inch) r TEST RUN BETWEEN /'S FT AND S� FT .1ev -�ro ' � a � /3 PERFORMED BY: LlontH+f 61' GNOo -'345 a5� CERTfFIED BY: J 79.nnn ran4i _ DATE: s S GREATER ANCHORAGE AREA BOr--.,UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 -y- INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /x'11-3TCU-HiE?r` MAILING ADDRESS 910Z /7/k' PHONE -3 LOCATION TR4)f'1-/RJe IM)h�))T 40(5 1916il?&-kkEGAL DESCRIPTION SEPTIC TANK: DISTANCE i NUMBER OF FROM WELLt1 ; MANUFACTURER heR —MATERIAf'� ��(� ) Irl ��COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY-' GALLONS. SEEPAGE PIT: �g '3, 1 i } NUMBER OF PITS f DIAMETER --OR WIDTH �')LENGTH� DEPTH 42 LINING MATERIAL /x CRIB SIZE: DIAMETERf' f DEPTH f I DISTANCE FROM: WELL �. ee) pI % TOTAL EFFECTIVE BUILDING FOUNDATION IL NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: e Z L✓lt TYPE CONSTRUCTION CONSTRUCTION_117 ,�,ecl DEPTH BUILDING NEAREST FOUNDATION—,LOT LINE CESSPOOL OTHERSOURCES APPROVED DISAPPROVED DISTANCES: `'1,1 INSTALLED BY: A'��.9r PIPE MATERIAL: _i!Lj�ja'Pa%til LOT SLOPE::q�� REMARKS: -%JPyjpij�_ n&r Ve.T riRiw- 16 A �4(hv/ 02 cpe- 'ft-ttivI—In V, K.. NEAREST SEPTIC SEWER LINE—,TANK _ REMA DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM _ r C 0 e `, r, N t i � c 4f pi N 1 + V{ r} DATE aZ J APPROVED v ✓—(r f' a . Ce', h G.A.A.B. /"i GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT /�'� , 3 P e-44✓7` A. MAILING ADDRESS INSTALLATION LOCATION / %^ % /s� LEGAL DESCRIPTION %� d%/ ({- /?/ ' J � �✓ ✓� ! / ��`"� INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED SEEPAGE PIT DRAIN FIELD OL OTHER , FINANCED THROUGH TO BE INSTALLED BY so1L TEST RESULTS /) R�' NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED [ J FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE 4'e �� TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK r / FOUNDATION TO SEEPAGE PIT a� � DRAIN FIELD SEEPAGE AREA SIZE SEPTIC TANK TO SEEPAGE PIT WALL /-a SEPTIC TANK �, SEEPAGE PIT �, DRAIN FIELD TO NEAREST LOT LINE. f n i WELL TO SEPTIC TANK j ��/' SEEPAGE PIT ��aa , DRAIN FIELD `J ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK L SEEPAGE PIT DRAIN FIELD_lt2 f { i SEPTIC TANK, SEEPAGE PIT �""('DRAIN FIELD. TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G .A.A .B. OR LICENSED DESIGNER I/ DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER A HORAGE AREA BOROUGH &OINANCE NO28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE. q /� ��gppLICANT'S SIGNATU RF_ 7 ._(,_>"�" O CREATER AINCK,1964CE AREA le -'B HEALTH DEPA�TMENI ' 0 327 LA%"!,F `,I'Rr",'CT, ANCMCMC-ra ALAFKA 9950 Perforftd fear Tom Stewart Date PerP)rmP(, 2 Jul Legal DescriprMOM*_ �b Homestead Hi=l This rcrm Reports a: S=01�g Loore� 7 r(=.1Mf7n s-,_ Soil Charlacteriztica The sediments were com- pact with a low to mod- erate water content. ,The contact between the Gm and Gm to Gw was erratic with respect to depth. Was Ground Water Encountered? No If Yes,, At What Depth Propoz.edIrustaall Sweepage Pit Drain ::4 Dene}, Of lnlatj . ft be 4�hTo COMMENTS: Two feet 'M. M4- i if r__.P4. Test Performed by. Percco bst'*' Certified -71 Location Sketch Municipality of Anchorage • 4 Development Services Department Building Safety Division x �_ On -Site Water and Wastewater Program ^' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak. us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-173-21 HAA # 0(1 - 631 ' Expiration Date: 1 GENERAL INFORMATION Complete legal description _ Lot 6 Block 2; Homestead Hills Subdivision Location (site address qr directions) 11331 BearRaw St. An borage. AK Current Property own,Er(s) Jason Boesl Day phone 632-8684 .,Mailing address 10109 Baffin St. Eagle River, AK 99577 Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. —14,4l 214211— 7 /ry/o ,/ 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Water Storage ❑ Community Class A Well [ Public Water System ❑ Individual On-site Ek Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid'for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034.N. Eagle River Loop Ste. 204 Eagle.River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 7 Wo y 5. DSD SIGNATURE Approved for Disapproved. 4 bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By. /%� _ / zz�j Original Certificate Date: 702 " 0 (Rev. 01/02) municipanty Of Andiorage Developmeht$6 m"'e" 6f, Building e y iy!sign & astewater P - rogr6m' uth rag S . ... ...... AK mc orage.ak.'u-s' sc i n:: 7' 4 Aid Milt Well Log (Y/')' iDee ed (Y/N) ground) _in. ,uc r9n 9-131M g.p,m� WN 2, R-�� "Mej"RA colonies/100 ml. Nitrate' mg./I. Other bacteria —polonies/1100'firil. mg./I. Date of sample: Collected by: T "77 "J, I - Z ft Date'instailled /0 /7 Ad 0 -3 - Na ED WWI I , iA Cleanouts (9/N) O"gal. Number of Compartments AL I, . . . . . . . . . . n c eanout N) Y1U Depression ;�er tank High water alai MUM I �777, 7-77 -7- imping Y Pumner A 4' '06. "em" -Rm�l 7777777 Z ISM W W, Xd 861'l rating (d. p:'d./ft' or ft =/bdrm System type cy 16-J Gravel below pipe ft. ft - 2 Monitoring tube Depression over field 0 s Wail) 5 Forj--bedrooms Its Pam, AR ----- gal. New depthY r in. .WV - -- '*4�, 411.-�, 11 �� 'I, .......... 7 in --A off level at in. � HJI � � ` � a arm level at in. tested Meets alarm& circuit requirements? Public sewer manhole/cleanout Holding tank JM *SEPT'VIHOODING TANk�*'ON'LO7 T0>" Property line s + Absorption field f Water service line )d Surface water /00 4 .. " t '4 Q.,.6 -S 76,0 4- + ieLermined tIIou"gli fieRUinspectrons and records that the above systems are in fOA HAA/guidelines in effect on this date. AFS xo 6 e /i 0/34,✓t7- C 0 wi4� ✓ f+�r.� !O g 1 �S npnt J 4 7-14-04;12:28PM;REMAX PROPERTIES ;907 2764429 * 2/ 2 1 hereby certifythat I have surveyed the following described property, Lot? Block .rqE OF .4� AlESTE'A!J H/L S 5*1/f02, Anchorage recording Precinct, Alaska, and_Ihat Qa••"••••ati'4. the Improvements situated thereon are within the property lines and do not overlapor (7 ••• •e �9,,� encroach on the property lying adiacent thereto, that no improvements on property /* f •, lying adjacent thereto encroach on the premises in question and that there are no roadways, r s L 49 •t x r.•• eeq•Newn•»•pNw• ... transmission lines or other visible easements on said property except as indicated hereon. /. - �I ��z Mildonea � mac$ No. 13084Anchorage, Alaska 3/ A�, /97�_ `� ui'",➢ es ••� h'ECERT/F/E P 7 JUDY 20e4 J. d. �% `onej•••».••••'NN 1 h 0FESStONP%-%)-- — — — — — — — — /o' dr/L. 5'Wr te .. j 9'B i : i N' � �•1 I t �1 / .' Na4sE1P I 571ANb F/pe's '7`,kNK \ bve2 .... 1 hereby certifythat I have surveyed the following described property, Lot? Block .rqE OF .4� AlESTE'A!J H/L S 5*1/f02, Anchorage recording Precinct, Alaska, and_Ihat Qa••"••••ati'4. the Improvements situated thereon are within the property lines and do not overlapor (7 ••• •e �9,,� encroach on the property lying adiacent thereto, that no improvements on property /* f •, lying adjacent thereto encroach on the premises in question and that there are no roadways, r s L 49 •t x r.•• eeq•Newn•»•pNw• ... transmission lines or other visible easements on said property except as indicated hereon. /. - �I ��z Mildonea � mac$ No. 13084Anchorage, Alaska 3/ A�, /97�_ `� ui'",➢ es ••� h'ECERT/F/E P 7 JUDY 20e4 J. d. �% `onej•••».••••'NN 1 h 0FESStONP%-%)-- Municipality of Anchoracye \V P.O. Box 196650 • Anchorage Mask, 99519-6650 •'relephone (907)343-8301 • F',,'(()'07)34,3-82()0 4700 Braga", Street • Anchorage, Alaska 99507 Mayor Mark Begich unew.muni.org Building Safety Division 15 Jul 04 S & S Engineering 17034 N. Eagle River Loop Suite 204 Eagle River, AK 99577 Subject: Waiver Request for Homestead Hills Block 2 Lot 06 Waiver Request #WR040046 Parcel ID 4015-173-21 Dear Mr. Cowan: Your request for a waiver of the required 10 feet from the Absorption Field to the Property Line is approved. The approved separation distance is 7 feet. This waiver approval applies to the existing Absorption Field to Property Line separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeff Poet Engineering Tech On -Site Water & Wastewater Program Community, Security, Prosperity MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES. i Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # LL - nl -a 1. GENERAL INFORMATION HAA #.. kA LO\lL ESS Complete legal description 2. h}tn,.nes%ece 14,/ll slb Location (site address or directions) 113,31 ecrr cc w S t Property owner 1.ou (S2 Pe f-ermu/►n Day phone 3 y6- 2 y Z3 Mailing address 1(331 (jarnoc..., SA Ajc 995-/6"-t5ty Lending agency _N..4 Day phone Mailing address Agent _Ctiuc Ic Nor4o - Ei r"12Son Re,=t E Fife Day phone 3q5-- /0'Z0 Address Unless otherwise requested, HAA will be held for pickup. *62 02 2. NUMBER OF BEDROOMS: A 3. TYPE OF WATER SUPPLY: Individual well Community well ✓ �G� `9� ��s�cF Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F(uf'fbn Tcchn-Ic«( S "cl Phone 34Y.5--1:3515- Address ys-f3515- Address IyS30 Ectio Sf. ,9-rcA&rczrgp, 46c 995'16 Engineer's signature �'� fi t_ Date S/(7 /96S 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments By: H" bedrooms, with the following stipulations: Date 6 " 7 - 2� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(R".1/91) BACK MOA a21 r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC-E C Environmental Services Division EIVED 825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-4744 MAY 2 0 1996 Municipality of Anchorage Health Authority Approval Checklist Dept. Health & Human Services Legal Description: 13/k? h6mesFiad /oil tr Parcel I.D.: —� A. WELL DATA Well type Cg.Cr 4 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: Date completed Cased to FROM WELL LOG Nitrate Casing height (above ground) Wires properly protected (Y/N) g.p.m. Collected by: AT INSPECTION Other bacteria g.p.m. B. SEPTIC/HOLDING TANK DATA 6/6/10s y Y Date installed t D 13 /7 H Tank size /G� Number of Compartments t Cleanouts (Y/N) Y Foundation cleanout (Y/1) y Depression (Y/N) N High water alarm (Y/N) N • A . Date of Pumping f / 2-1 / 9S Pumper R a /o Roah r C. ABSORPTION FIELD DATA Date installed 6 Soil rating (g.p.d./ftz or 112/bdrm) 2 Z5 System type 7-rencA Cr Length _ I p Width 3 Gravel thickness below pipe 6 Total depth 91 Effective absorption area 13 0,Y Monitoring Tube present(Y/M Y Depression over field (Y/N) N Date of adequacy test 5-/ / `/ / 9 6 Resuly(Pass/Fail) pass For 1-/ bedrooms 17 on Nw W wx #n NW #h N 17 7/y )nN Fluid depth in absorption field before test (in.); vin M E Immediately after6�/gal. water added (in.): a 0 17 to NW ,N'/8 007N t 89 Abso tionrate = 6Gp d. Fluid depth a i� Ale (ins.) Minutes later: rp ' g.p. Peroxide treatment (past 12 months) (Y/1) Alolie (zr c w,7 If yes, give date D. LIFT STATION N on e Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* "Pump off' level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots — On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 F from c. G, Property line Ko Absorption field 2s– > S> 'ZGC! 10 cc. rh nr Water main/service line %:e 10 Surface water/drainage *> I 0o' Wells on adjacent lots :Z t 0o' ly la -v f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 21 Property Line 12 Water main/service line 10 ' Surface water > 10 0 Driveway, parking/vehicle storage area > ZOO' AP Cc�nrw+ Curtain drain None SeOn Wells on adjacent lots > 14 0' fv F. ENGINEER'S CERTIFICATION �» f. I certify that have determined thru field inspections and review of Municipal records' thatxhe bbveysterrt3; re A in conformance with MOA HAA guidelines in effect on this date. Py Signature J✓^� J' %%1e�-e+ c > 4 , a • • a r . » .. o 4s - •e•i •• • 60 �bn e�p Engineer's Name %`►taoPav� F. /`tc>cr� , .Ag - e01�a;, ere 2, V V✓ Date MO -4 17 HAA Fee $ Date of Payment Receipt Number —Z to tP O Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number M !Ply 577-D 1-/k"i 1 �l:�c�nr✓( bN 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE \� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 • ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. In omplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPER OWNER G" 6o il/ D 5E` ff A� PHO 8/�6 MAILING DRESS 46-4-A J" �i l�V '�7 rT /� �U /V C/'7 Q� PROPER RESIDENT (If different from above) PH E 2. BUYER PH E 1L 7. WATER SUPPLY ED INDIVIDUAL* MAI LING ADDWS� &-' U �✓ %� f✓ HON3. LENDING INSTITUTI N E since June 1975. For wells drilled prior to that date, give well MAILING ADDRESS PHONE 4.. REAL R/AGENT .HSd �� L ✓ v �� 9 ' MAILING ADDRESS V ✓ 9 1 TGSS bN 5. LEGAL DESCRIPTION '+' �/ +J�Cf G� STREET LOCATION �� ✓ / 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ❑ Four ❑ Other �j One SSU SINGLE FAMILY ❑ Two ❑ Five /❑ MULTIPLE FAMILY 09::/ Three ❑ Six 7. WATER SUPPLY ED INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM '7 7J �J INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequac test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) n 'may/-j)�a•,,.,,�- 1._- THIS SIDE FOR OFFICIAL USE ONLY - INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED OM.Xt (C(-7 INSTALLER ❑Septic Tan or ❑Holding Tank Size: O� If Tank is homemade. give dimensions: SOILS RATING TYPE OF TANK MANUFA TURER TOTAL ABSORPTION AREA (D W MATERIAL , f� Y, 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑�DITIONAL APPROVAL (letter must accompany certificate) DISAPPROVED rZ DATE —.— BY (Title) LEGAL DESCRIPTION C1 2-0 1U kNev. Biro) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received .3-- L Time of Inspection,d 3 v Date of Inspection 4/--/0—/57 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES c, FOR 1. Approval requested by: Mailing Address: Phone: .9 2'7- 2. 7- 2. Property Owner: ��j� �,� �r,�, Phone: Mailing Address: 3. Legal Description: 4. Location: zj,/,/ '/,I d 5. Type of facility to be inspected No. of bedrooms 6. Well Data:. (_� �a. O� �m l e� , c e� A. Type C. Construction D. Bacterial Analysis B. Installer C. Septic Tank: 1. Size 11,900 2. Manufacturer D. Seepage Pit: 1. Absorption rea ��a 47' 2. Material E. Disposal Field: Total length of lines I B. Depth 7. Sewage Disposal System: A. Installed /o— -3— -741- 8. Distances: A. Well to: Septic tank �,r®�� , Absorption area Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank /6 / , Absorption area 1�'�f C. Absorption area to nearest lot line 'A ©�� Fn-nla i1/74i Dann 1 of +wn nnnnc GREATER ANCHORAGE AREA BOROUGH.._. Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: C14RO VA FHA CONV 2. Property Owner: Mailing Address: Day Phone. 3. Name of Buyer:�`}�//— jl-v7 Mailing Address: �nC� AV 7350 Day Phone 4. Name of Lending Institution: /( /?iG(j 11 / Mailing Address: Phone 5. Name of Realtor or.Agent: 10"u�✓z5' Mailing Address: Phone 2_.77 6. Legal Description: )— <<= r � //�` /+)ee 'i i=/I"j Location: f/4A)i�s 7. Type of Facility to be inspected: No. Bdrms. Z_ 8. Water Supply Type of Supply: ire' -Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility _ If Individual, date of installation EO -037 11/74) Individual (on-site) c Page 2 of two pages - Re(' --"'S For Approval of Individual "� Water Facilities Legal ,Description _ ? «�'' { ,. 2, t V-4 Comments Approved f Disapproved Date Appro 1,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) )XO -Z4 /I a_,4